Florida YIG: Chapter Intent to Participate Form
Planning on participating this year? Please let us know some information about you and your group, so that we can follow-up with you.

Please submit one entry for EACH High School or Middle School Chapter, no later than the first Wednesday in October.

Program Year
Please select the current Program Year
Chapter Information
High School or Middle School Chapter
Who will your Chapter serve?
Chapter Name
The name of your Chapter as recognized by the State Office
Delegation Name
If your delegation name isn't listed, please contact registration@floridayig.net
YMCA or School Based?
Is your Chapter YMCA or School Based?
Estimated Number of Members
How many registered members do you think your Chapter will have during the 2015-2016 Program Year?
Your answer
Estimated Number of State Assembly Attendees
How many members do you think your Chapter will send to State Assembly this program year?
Your answer
Estimated Number of Jr. Assembly Attendees
How many members do you think your Chapter will send to Jr. Assembly this program year?
Your answer
Chapter's Host YMCA/School/Organization
Name of Host YMCA/School/Orgainzation
Name of the YMCA/School/Organization that hosts your program.
Your answer
YMCA/School/Organization Address
Street Address
Your answer
YMCA/School/Organization Address
City
Your answer
YMCA/School/Organization Address
Zip Code
Your answer
Lead Chapter Advisor
Lead Chapter Advisor: First Name
First Name of Chapter's Lead Advisor
Your answer
Lead Chapter Advisor: Last Name
Last Name of Chapter's Lead Advisor
Your answer
Lead Chapter Advisor: E-mail address
Your answer
Additional Advisor Information
Please list any additional advisors who you would like to have updates sent to - (First & Last Name, Email Address)
Your answer
School Administrator (for School Based Chapters ONLY)
School Administrator: First Name
If School Based - Name of Administrator who has given approval for Chapter to exist on campus
Your answer
School Administrator: Last Name
If School Based - Name of Administrator who has given approval for Chapter to exist on campus
Your answer
School Administrator: Email address
If School Based - Email Address of Administrator who has given approval for Chapter to exist on campus
Your answer
Local YMCA Branch Contact
Local YMCA Branch Contact: First Name
First Name of your local YMCA Branch Contact
Your answer
Local YMCA Branch Contact: Last Name
Last Name of your local YMCA Branch Contact
Your answer
Local YMCA Contact: E-mail address
Your answer
Chapter President
Chapter President: First Name
First Name of Chapter President
Your answer
Chapter President: Last Name
Last Name of Chapter President
Your answer
Chapter President: E-mail address
Your answer
We the Student Leadership & Adult Advisors of our Chapter knowledge that:
Please check the boxes below to signify your understanding and compliance with the following statements:
Required
We agree to:
Required
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